Provider Demographics
NPI:1528198694
Name:RIVERA, ASTRID GRISEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:GRISEL
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1838
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-1838
Mailing Address - Country:US
Mailing Address - Phone:787-832-7455
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE DR NELSON PEREA
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4949
Practice Address - Country:US
Practice Address - Phone:787-832-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice